Context.
Historically, surgical training involved an apprenticeship model provided almost exclusively in a hospital setting. Residents performed surgery under the supervision of more experienced surgeons. The type of situations presented to the surgeon trainee was largely driven by chance as the nature and timing of situations needing surgery found in patients was not under anyone's control. This model of using a stream of situations as presented by clinical service of human patients does not provide a model for repetition until mastery. As the number of hours that residents are available for surgery has decreased, the range of surgical events presented to surgical residents has decreased. The failure rate for surgery board certification exams is now in the range of 26 percent. For specialized board certification such as thoracic surgery, the rate has been as high as 33 percent.
Virtual reality training based on the field sometimes called serious gaming or alternative learning techniques has value for teaching medical providers interviewing or diagnostic skills. Virtual reality training may be of use for demonstrating the ability to prioritize in triage and for showing knowledge of the sequence of steps but does not allow practice of the specific tactile skills used in surgical processes.